Question

Patient Introduction

Vincent Brody is a 67-year-old male admitted directly from the provider’s office several hours ago for exacerbation of his chronic obstructive pulmonary disease (COPD). He is maintaining O2 saturations at 94% on 2 L/min of oxygen per nasal cannula. IV of potassium chloride in 5% dextrose and normal saline is infusing at 100 mL/hr in his right hand. He has responded well to medications and treatments and appears to be resting. He continues to have a productive cough. Patient has a 50-year history of smoking 2 packs a day. During the last year he has had two exacerbations. Physical findings include a barrel chest and clubbed fingers.

Medical Case 3: Vincent Brody

Guided Reflection Questions

1.   How did the scenario make you feel?

2.   When a patient develops a rapid onset of shortness of breath, what are the nurse’s immediate priorities?

3.   What assessment findings would indicate that the patient’s condition is worsening?

4.   Review Vincent Brody’s laboratory results. Which results are abnormal? Discuss how these results relate to his clinical presentation and chronic disease process.

5.   What are safety considerations when caring for a patient with a chest tube?

6.   What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.

7.   What patient teaching priorities would be important in the patient experiencing an acute exacerbation of COPD?

8.   For a patient with COPD who is stable, what resources would you recommend?

9.   What would you do differently if you were to repeat this scenario? How would your patient care change?

Answer 1

1.The scenario makes one feel that the patient is experiencing a severe exacerbation of the disease condition (COPD) The patient has been stabilized with oxygen and medication

2.The immediate action to be done by a nurse to manage shortness of breath is by

• Making the patient sit in propped up or fowlers position ,this will increase the lung capacity
• Administer oxygen after assessing the SPO2 if less than 90%
• Inform the physicia3
• Bronchodilator,Anticholenergic drugs can be administered as per order to relive bronchial constriction

3.The assessment which indicates the patient is worsening are

• sudden onset of dyspnea can be a sign of heart failure,pneumonia, embolus
• Patient using accessory muscles to breath
• Hypoxia
• Unstable vital signs
• Inspiratory and expiratory wheeze
• Barrel shaped chest is an advance stage of emphysema
• Decreased breath sounds
• Early inspiratory crackles and forced expiratory time

4.The patient with COPD will have the following laboratory value changes

• ABG reveals the payient will be having increased carbondioxide level
• Deficiency of Alpha 1 antitrypsin (smoking)
• Decreased oxygen level notified in the pulse oximeter